Independent volumetric internal fixation reduces posterior column acetabular fracture site motion as compared to plate/screw construct: A biomechanical analysis.

Aims & objectives: To establish whether a suprapectineal pelvic reconstruction plate and posterior column screw (P&S) construct or a single 6.5-mm cannulated posterior column screw (PCS) construct demonstrates greater mechanical stability for fixation of acetabulum fractures involving the posterior column (PC). We hypothesized that the PCS construct would result in less fracture site motion. Materials & methods: Twelve fourth-generation composite hemipelvi were utilized, 6 for each construct. The P&S construct consisted of a suprapectineal pelvic reconstruction plate with two 3.5-mm posterior column screws crossing the fracture site in lag-by-technique fashion and two screws anchoring the plate to the sciatic buttress. The PCS construct consisted of a single 6.5-mm partially threaded cannulated screw placed in an antegrade fashion. Both fixation models were cyclically loaded at 0.5 cycles/second at 400N and 800N, first in a sit-to-stand position that is expected during recovery, and subsequently in a squat-to-stand position to test overload conditions. Results: Under sit-to-stand loading, the PCS construct resulted in less motion at the fracture site than the P&S construct (0.06 ± 0.02 mm vs 0.1 ± 0.02 mm at 400N, p = 0.02; 0.13 ± 0.03 mm vs 0.19 ± 0.04 mm at 800N, p = 0.03). The PCS construct also demonstrated less fracture site motion under squat-to-stand loading (0.22 ± 0.13 mm vs 1.9 ± 0.5 mm at 400N, p = < 0.001; 1.48 ± 0.44 mm vs 4.77 ± 0.3 mm at 800N, p = < 0.001). At 800 N, half of the repairs failed during squat-to-stand loading (2 PCS, 4 P&S). Conclusion: Fixation of the posterior column of the acetabulum with a 6.5-mm cannulated screw demonstrated comparable fracture motion upon loading compared to the plate and screw construct.

A novel technique for C1-C2 posterior screw insertion using patient-specific guides created by CT-based 3D printing.

C1-C2 fixation has been developed for the rigid fusion of atlantoaxial instability. C1 lateral mass screw (C1 LMS)-C2 pedicle screw fixation is used more frequently due to its rigid fixation and high bone fusion rate. However, C1 screw placement is relatively unsafe even with recently developed image-based navigation systems. Patient-specific screw guide templates (PSGT) were developed to improve the accuracy and safety of C1 screw placement. Herein, we investigated the outcomes of the C1-C2 posterior fixation technique using PSGT. This was a retrospective study of six patients who underwent posterior cervical spinal fusion using the PSGT between January 2022 and April 2023. Operative time, estimated blood loss, intraoperative radiation dose, surgical cost, and screw placement accuracy were evaluated and compared with those achieved with preoperative CT-based navigation (navigation group, n = 15). Screw accuracy was assessed using Neo's classification. PSGT showed good results, although the differences were not statistically significant (operation time: 104.3 ± 9.7 min vs 116.4 ± 20.8 min; estimated blood loss: 56.7 ± 72.4 mL vs 123.2 ± 162.3 mL; and radiation dose: 1.8 ± 1.2 mSv vs 2.6 ± 0.8 mSv, respectively). PSGT was particularly better in terms of the accuracy of C1 LMS (PSGT: 100%, navigation: 83.3%). The deviation at the entry point was minimal, and the difference between the sagittal and transversal angles from the preoperative plan was small. We investigated the clinical efficacy of using the PSGT for C1-C2 posterior fixation. PSGT improved the accuracy of C1 LMS insertion.

Investigation of the appropriate thread depth for bioabsorbable screws.

The relatively low strength of bioabsorbable screws is a critical clinical issue. A shallower thread depth will increase a screw's strength, but the pull-out strength of the screw will decrease proportionally with the thread depth. We sought to provide further clarification of the relationships between (i) the thread depth and the pull-out strength, and (ii) the minor diameter and the shearing and bending strengths in bioabsorbable screws made of uncalcined and unsintered hydroxyapatite particles and poly-L-lactide (u-HA/PLLA). Seven types (thread depth from 0.1-0.7 mm) of screws with a major diameter of 4.5 mm were manufactured. Each screw type's pull-out strength was investigated using simulated bone. A shearing test and three-point bending test were both used to measure the physical strength of the screws. We then analyzed the relationships between the mechanical findings and the thread depth. The relationship between the thread depth and the pull-out strength showed a positive biphasic linear correlation with a boundary at 0.4-mm thread depth. The relationships between the minor diameter and both the shearing and bending strengths showed positive linear correlations within the range of dimensions tested. Within the scope of this study, a 0.4-mm thread depth proved to be an appropriate value that provides sufficient pull-out strength and screw strength for u-HA/PLLA screws with a 4.5-mm major diameter.

Comparison of three implant systems under preload loss: A finite element analysis validated by digital image correlation methods.

PURPOSE: This study evaluated the effects of screw preload loss on three implant systems, both in silico and in vitro. METHODS: Three finite element analysis (FEA) models of implant restorations were created using bone-level (BL, 4.8×12 mm; BLX, 4.5×12 mm) and tissue-level (TL, 4.8×12 mm) implant systems. The screws in each group were subjected to preloads of 100 N and 200 N, with an additional 130 N load applied to the crown tops. An in vitro study of the principal strain was conducted using digital image correlation (DIC) under the same conditions as for the FEA models. The results were evaluated for von Mises stress, principal strain, and sensitivity index. RESULTS: During loading, the highest stress levels were observed in the implants and screws. In the BL group, the screws experienced the highest von Mises stress at 466.04 MPa and 795.26 MPa in the 100 N and 200 N groups, respectively. The BLX group showed the highest von Mises stress at 439.33 MPa and 780.88 MPa in the implants in the 100 N and 200 N groups. Sensitivity analysis revealed that the screws and abutments in the TL group were significantly more affected by the preload changes. CONCLUSIONS: The abutment in the TL group was particularly sensitive to preload changes compared with those in the BL and BLX groups. Variations in the preload significantly affect the stress distribution in implants and screws. Maintaining screw preload stability under loading is crucial in clinical practice to prevent mechanical failure.

Stress Analysis of Periodontal Tissue in en Masse Retraction With Integration of Maxillary Anterior Teeth: A Three-Dimensional Finite Element Method Study.

OBJECTIVE: To simulate the en masse traction technique with the integration (EMTI) of six maxillary anterior teeth using a finite element model (FEM) and explore various protocols for maxillary protrusion. The study aimed to investigate root displacement and stress distribution in the periodontal ligament (PDL) by varying the retraction position and direction of EMTI applied to the maxillary anterior teeth. No actual participants were involved. MATERIALS AND METHODS: The FEM model included six teeth (central and lateral incisors and canines) with a PDL thickness of 0.3 mm. The model encompassing the alveolar bone (ALB) and EMTI had 180,528 elements and 47,836 nodes. The EMTI integrated six anterior teeth via a 0.9-mm-diameter stainless steel lingual wire, equipped with three moment arms extending toward the root apex: one midline (central arm) and two distal to the canines (lateral arms). The position and direction of the traction force applied to the three moment arms of the EMTI were varied to assess crown and apex displacement, as well as PDL stress. RESULTS: Lingual tipping was consistent across all protocols, emphasizing controlled incisor tipping. The application of horizontal traction at 10 mm and traction at 7 mm from the central and lateral arms of the EMTI, respectively, demonstrated the most uniform stress distribution across the PDL of all six anterior teeth. CONCLUSIONS AND CLINICAL SIGNIFICANCE: The FEM analysis results suggest that the new EMTI method, which retracts the maxillary anterior teeth as a unit, is effective for tooth movement and PDL stress distribution. The EMTI technique, with its specific traction protocols and emphasis on controlled tipping, appears to be a promising approach for addressing maxillary protrusions.

The Effect of Osteopenia and Osteoporosis on Screw Loosening in MIS-TLIF and Dynamic Stabilization.

STUDY DESIGN: Retrospective series. OBJECTIVE: Screw loosening in the surgical treatment of lumbar spine disease is a major complication of osteopenia or osteoporosis. This study investigated the risk of screw loosening following either MIS-TLIF or pedicle screw-based dynamic stabilization (DS) in patients with osteopenia or osteoporosis. METHODS: We retrospectively enrolled patients receiving 1- or 2-level MIS-TLIF or DS in a single institute. All patients were diagnosed as having lumbar spondylosis without concurrent spondylolisthesis and found by dual-energy X-ray absorptiometry to have osteopenia or osteoporosis. Screw loosening was identified by X-ray and CT. Clinical outcomes were also assessed. RESULTS: A total of 103 patients (50 MIS-TLIF and 53 DS) were confirmed to have osteopenia (-2.5

Delayed neurological deficit due to a medially misplaced thoracic pedicle screw during adolescent idiopathic scoliosis correction: a complication 6 years in the making.

PURPOSE: Neurological deficits developing years after pedicle screw misplacement is a rare phenomenon. Here, we report level IV evidence of a previously asymptomatic medial thoracic pedicle screw resulting in paraparesis after a motor vehicle accident. METHODS: A 21-year-old male presented with acute onset of paraparesis following a motor vehicle collision. Six years prior this incident, the patient underwent a thoracolumbar fusion T4-L4 for AIS performed by an outside orthopedic surgeon. CT scan and CT myelogram illustrated decreased spinal canal diameter and cord compression from a medial T8 pedicle screw. RESULTS: Surgical removal of the misplaced pedicle screw resulted in a gradual complete recovery sustained over a period of 2 years. This case is compared to those reported in the literature review between 1981 and 2019 concerning delayed neurological deterioration related to misplaced pedicle screw. CONCLUSION: This case reports a delayed neurological deficit implicating a misplaced pedicle screw. This phenomenon remains rare since 5 cases were reported in the literature over the last 4 decades. It calls into focus the need for confirmation of safe instrumentation during the intraoperative period. It also illustrates the potential difficult decision-making in regard to asymptomatic misplaced instrumentation. LEVEL OF EVIDENCE: IV.

The infraacetabular screw - anatomy, radiology, biomechanics and clinics.

Acetabular fracture surgery follows the primary aim of anatomic reduction and rigid stable fixation of the fracture. Infraacetabular screws (IAS) allow for an increased stability of the acetabular fixation by closing the periacetabular fixation frame without requiring an additional posterior approach. The osseous screw corridor for infraacetabular screws use the transition zone between the acetabular ring and the obturator ring. The infraacetabular screw corridor (IAC) shows a double-cone shape with an isthmus located near the acetabular fovea. The iliopectineal eminence (IE) is mainly used as a clinical landmark for the intraoperative assessment of the entry point of IAS. The inlet view, the combined obturator oblique outlet view and a 1/3 iliac oblique outlet view may be used for the intraoperative radiological assessment for both the entry point and the screw trajectory of IAS. Several biomechanical studies have shown that IAS increase the stiffness of the internal fixation. Scientific proof for an improved clinical outcome is still missing.

Outcomes of Femoral Neck System in Treating Intra-capsular Neck of Femur Fractures in a Young Adult: A Case Report.

The introduction of the Femoral Neck System (FNS) represents a promising alternative to traditional cancellous cannulated (CC) screw fixation for managing intra-capsular neck of femur (ICNF) fractures. This case report aims to validate its safety and report the outcomes in a young patient. The findings demonstrate that the FNS possesses excellent biomechanical properties and provides significantly greater overall construct stability bearing in mind, that it was used in a Pauwels Classification Grade 3 ICNF fracture.

Robotic-assisted surgery for adult spinal deformity. A systematic review.

Purpose: The goal of this systematic review is to offer a detailed summary of the present status of robotic-assisted surgery for adult spinal deformity. Methods: This review is based on articles systematically searched in PubMed, Medline, and Web of Science Core Collection databases on robotic-assisted surgery for adult spinal deformity. Differences in the precision of pedicle screw placement, duration of surgery, and incidence of complications between robotic-assisted surgery and the conventional open surgery were considered. Results: A total of 172 articles were retrieved from the literature search. A total of 168 articles were excluded. Therefore, this systematic review included the remaining four original articles, including accuracy of pedicle screw placement, operative time, radiation exposure, intraoperative and postoperative complications, respectively. The overall level of evidence in the studies was moderate to low. Conclusion: Robotic-assisted surgery for adult spinal deformity demonstrates the potential to enhance the precision of screw placement, possibly reduce intraoperative and postoperative complications, and decrease radiation exposure. However, the impact on operation duration requires further investigation.

Patient-reported and radiological outcomes of short Scarf osteotomy fixed with a single screw: A prospective study of 271 osteotomies.

The Scarf osteotomy involves inherent risks and technical challenges. The short scarf osteotomy with single screw fixation has emerged as an alternative approach. This study aims to evaluate the patient-reported outcome measures (PROMs), radiological outcomes, and complications associated with the short scarf osteotomy fixed with a single screw for hallux valgus correction. A prospective cohort study was conducted between October 2018 and October 2023 at a single center, encompassing 271 osteotomies. PROMs were collected prospectively preoperatively and at various postoperative intervals. Radiographic data, including hallux valgus angle (HVA) and intermetatarsal angle (IMA), were measured preoperatively and six weeks postoperatively. Complications were also documented. Statistically significant improvements were observed in all PROMs and were sustained up to 24 months postoperatively. The Visual Analog Scale (VAS) pain score demonstrated a significant reduction from 46.97 at baseline to 12.52 at 24 months (p < 0.001). Likewise, the EQ-5D score improved notably from 0.73 preoperatively to 0.81 at 24 months (p = 0.002). Analysis of the Manchester-Oxford Foot Questionnaire (MOXFQ) revealed substantial improvements across its pain, walking/standing, and social interaction domains over the same period, with all changes showing statistical significance (all p < 0.001). Radiographically, the mean HVA improved significantly from 31.33° preoperatively to 13.33° postoperatively (p < 0.001). Similarly, the mean IMA improved significantly from 14.67° to 7.66° (p < 0.001). The most common complication was superficial wound infection, effectively managed with oral antibiotics. The were no cases of avascular necrosis or fracture. In conclusion, the short Scarf osteotomy fixed with a single screw demonstrates favorable outcomes. These findings support its efficacy and safety as a treatment option, with potential advantages over the conventional technique. Further prospective studies are warranted to validate these findings.

Differences in gait analysis and clinical outcome after dynamic fixation or screw fixation in acute syndesmosis tear: a prospective randomized pilot study.

INTRODUCTION: Acute syndesmosis tears can be treated by static screw or dynamic fixation. Various studies have compared these techniques regarding postoperative outcome. However, to our knowledge, no study has used 3D-instrumented gait analysis (IGA). We hypothesized that a dynamic fixation would perform non-inferior to screw fixation in terms of biomechanical and clinical outcomes. MATERIALS AND METHODS: Patients were prospectively randomized to both groups. All patients received the same follow-up rehabilitation and consultations (6 and 12 weeks; 6 and 12 months) postoperatively. Standardized questionnaires were used to objectify pain and ankle function. At 6 months follow-up, IGA was conducted additionally to objectify the biomechanical outcome. RESULTS: Twenty-five patients in the dynamic fixation (DF) group using TightRope® and twenty-five in the screw fixation group (SF) completed gait analysis. The DF group showed significantly higher mean values for maximum moment in the affected ankle joint (DF: 1.40 ± 0.21 Nm, SF: 1.23 ± 0.30 Nm; p = 0.023) and the unaffected ankle joint (DF: 1.52 ± 0.20 Nm, SF: 1.37 ± 0.27 Nm; p = 0.035). The difference between the affected and unaffected ankle joint was significantly higher in the SF group for active plantarflexion (DF: 1.52 ± 0.20°, SF: 1.37 ± 0.27°; p = 0.035). Both dynamic and screw fixation groups exhibited significantly reduced plantarflexion during the push-off and early swing phase, with moments and powers in the ankle joint also significantly impaired. CONCLUSIONS: Our study demonstrated that dynamic fixation has better or similar biomechanical and clinical outcomes compared to screw fixation. Future research should focus on biomechanical differences during gait as well as clinical outcomes in case of earlier weight-bearing after dynamic fixation. TRIAL REGISTRATION NUMBER (TRN): DRKS00013562 Date of Registration: 07/12/2017.

Surgical Management of Type II Odontoid Fractures in a Resource-Limited Setting: A Case Series.

Type II odontoid fracture, classified by Anderson and D'Alonzo, is the most common traumatic injury to the odontoid process. Surgical management of this lesion is particularly challenging in underresourced countries. This study aims to report the preliminary experience of the Kinshasa University Teaching Hospital in Kinshasa, Democratic Republic of the Congo, particularly using adaptive techniques. Three patients, aged 22, 30, and 32 years, respectively, were admitted to the neurosurgery department with Anderson and D'Alonzo type II odontoid fractures as confirmed by CT scan imaging. The first two patients underwent anterior odontoid fixation using a non-cannulated orthopaedic screw with an image intensifier. In the third case, partial resection of the C1 posterior arch was performed, followed by immobilisation using a rigid Philadelphia neck brace. Postoperative follow-up in all three cases was uneventful, and neurological outcomes were satisfactory. Odontoid surgery remains challenging for developing countries. The use of a non-cannulated orthopaedic screw for anterior fixation and posterior spinal cord decompression via partial resection of the C1 posterior arch, followed by external cervical immobilisation with a rigid neck brace for neglected fractures, could be effective alternatives to conventional surgical techniques. However, randomised multicentre studies are required to confirm the efficacy and safety of these techniques.

Comparative biomechanical study of different screw fixation methods for minimally invasive hallux valgus surgery: A finite element analysis.

BACKGROUND: There are different screw configurations utilised for minimally invasive hallux valgus (HV) deformity despite limited biomechanical data assessing the stability and strength of each construct. We aimed to compare the strength of various screw configurations for minimally invasive HV surgery using finite element analysis (FEA). METHODS: A FEA model was developed from a CT of a female with moderate HV deformity. Five screw configurations utilizing one or two bicortical or intramedullary screws were tested. Stress analysis considered osteotomy displacement, maximum and minimum principal stresses, and von Mises stress for both implants and bone for each screw configuration. RESULTS: Fixation with two screws (one bicortical and one intramedullary) demonstrated the lowest values for osteotomy displacement, minimum and maximum total stress, and equivalent von Mises stress on the bone and screws in both loading conditions. CONCLUSION: The optimal configuration when performing minimally invasive surgery for moderate HV is one bicortical and one intramedullary screw. LEVEL OF EVIDENCE: Level III.

Cannulated compression screws with cable technique leads to a dramatic reduction in patella fracture fixation complications compared to tension band wiring.

INTRODUCTION: The aim of this study was to compare the clinical, radiological and functional outcomes between cannulated compression screw with cable construct (CS) and tension band wiring (TBW) in transverse patella fractures. MATERIALS AND METHODS: A retrospective study was conducted on patients surgically treated for AO/OTA 34C1 or 34C2 transverse patella fractures with CS or TBW technique between January 2019 and January 2023. Clinical outcomes included complications related to the implant, wound and fracture at 6 months and 1 year, time to achieving full weight bearing status and early perioperative clinical outcomes. Radiological outcomes included the time to fracture heals and delayed union. Functional outcome measures using the Oxford Knee Scale, 36-short form questionnaire and the Bartlett Anterior Knee Score were assessed. RESULTS: 73 patients were treated with CS (n = 33) or TBW (n = 40). TBW had higher complication rates: 25.0% (n = 10) required implant removal, 12.5% (n = 5) had wire breakage, 12.5% (n = 5) experienced fracture displacement while 52.5% (n = 21) experienced implant migration. In contrast, no CS patients had implant removals, wire breakage or fracture displacement and 3.0% (n = 1) experienced implant migration. At 1 day post-operatively, 87.9% (n = 29) CS group patients were able to ambulate as compared to the 55.0% (n = 22) of TBW patients. Furthermore, CS patients ambulated further distances at 11.8 ± 10.6 m than the TBW group (6.4 ± 7.4 m). The CS group (25.9 ± 24.6 days) also achieved full weight bearing status faster than the TBW group (43.6 ± 39.4 days). The time taken for the fracture to heal and functional outcomes were comparable among the two groups. CONCLUSIONS: The CS technique demonstrated lower complications, in particular, no CS patient had implant removals, wire migration or fracture displacement. Additionally, CS technique showed a faster return to ambulation and time to achieving full weight bearing status.

Functional Outcome of Forearm Fractures Managed With Screw Nails vs. Dynamic Compression Plates: A Prospective Study.

Background Fractures of the forearm are very frequently encountered in day-to-day practice. These fractures have a bimodal age distribution. The forearm fractures are considered intra-articular and need absolute stability for adequate healing. The current treatment modalities include using intramedullary devices such as a square nail, locking intramedullary nail, or using a plate for fixation. In this study, we aim to determine the functional outcome of forearm fractures managed with a screw nail used as an intramedullary device as compared to a locking plate using the Grace-Eversmann criteria. Methodology Patients with forearm fractures were divided into two groups and treated with a screw nail and a dynamic compression plate. Patients were followed up at one month, three months, six months, and one year postoperatively and assessment was done using the Grace-Eversmann criteria. Results The study included a total of 30 subjects, ranging in age from 18 to 65. The majority of the patients had encountered a road traffic accident, following which they incurred a forearm fracture. Grace-Eversmann criteria was used for these patients at follow-up, and a total of 13 patients (86.6%) had good to excellent scores, which was similar when compared to the plate osteosynthesis group (86.6%). A significant difference in the amount of blood loss was noted in the screw nail osteosynthesis group as compared to the plate osteosynthesis group (p<0.05). Conclusions Though a dynamic compression plate is considered a standard method for fixation of the forearm fractures, the use of an intramedullary screw nail as a fixation device gives a similar result with excellent functional outcomes (Grace-Eversmann criteria). It also gives an added benefit of reduced blood loss and preservation of fracture biology.

Innovative 3D Navigation Module for Precise Unilateral Pedicle Screw Combined with Contralateral Translaminar Facet Screw Placement in Lumbar Spine Surgery.

OBJECTIVE: The incidence of degenerative diseases of the lumbar spine has increased in recent years. Unilateral pedicle screw combined with contralateral translaminar facet screw fixation offers the advantages of less trauma, better stability, and fewer complications. However, the surgical difficulty and suboptimal pinning accuracy of translaminar facet screw placement in clinical practice limit its use. Therefore, in this study, we designed a novel suspended 3D-printed navigation module to facilitate fast and accurate intraoperative screw placement. The aim of this study is to investigate the digital design, precise implementation, and evaluation methods for placing unilateral pedicle screws in the lumbar spine combined with translaminar facet screw placement using a new suspended 3D navigation module. METHODS: This retrospective study included 46 patients with single-level lumbar lesions who underwent spine surgery at the Affiliated Hospital of Putian University between June 2022 and December 2023. The suspended navigation module was designed digitally. Preoperative screw placement was simulated using 3D printed models, followed by an intraoperative accurate screw placement facilitated by the navigation module and a postoperative evaluation of the accuracy of screw placement. The absolute difference in three-dimensional coordinates of the inlet and outlet points of the preoperative design and the postoperative screw-nail channel served as the precision index. RESULTS: In a study involving 46 patients, surgery was successful with 92 pedicle screws and 46 translaminar facet screws placed without any penetration of the cortex. The difference in coordinates before and after screw insertion was minimal, with entry points varying between 1.21 to 1.36 mm and exit points between 1.97 to 2.46 mm. When screw accuracy met certain thresholds, there was no significant difference between preoperative design and postoperative coordinates, indicating precise replication of the surgical plan. CONCLUSION: The new suspended 3D navigation module enables the precise placement of unilateral pedicle screws in the lumbar spine combined with translaminar pedicle screws for precise surgery.

A new approach for percutaneous ilio-sacral screw fixation: CT-based pre-operative planning with conventional fluoroscopy to reduce malposition rate and operating time.

PURPOSE: Percutaneous ilio-sacral screw (ISS) insertion using conventional C-arm fluoroscopy has been a widely employed technique for pelvic posterior ring fixation, particularly in developing regions. However, this approach presents technical challenges, leading to a high malposition rate. We introduced a new method for ISS insertion without additional equipment or software and suggested whether it could reduce the malposition rate and operating time. METHODS: This is a retrospective cohort study. The study included all patients who underwent percutaneous ISS fixation between January 2020 and December 2022. Patients treated with open reduction or other types of implants were excluded. The patients were divided into 2 groups based on the screw insertion method: Group A utilized the traditional dual-plane adjustment method, while Group B received the newly introduced method. In all cases, conventional C-arm fluoroscopy was the sole guidance during the surgical procedure. Malposition rate, radiation exposure, and operating time were compared between groups. Post-operative CT scans were used to assess screw accuracy using the Smith grading method. The Student's t-test or the Mann-Whitney U test was chosen for comparing the quantitative variables based on the normality test results. The Chi-squared test was utilized for comparing qualitative variables. RESULTS: A total of 72 patients with pelvic posterior ring disruption treated with percutaneous ISS under conventional fluoroscopy guidance were included in this study. Among them, 32 patients were in Group A and 40 patients were in Group B. In Group B, the average operation duration per screw was 33 min with 29 fluoroscopy applications, which was significantly lower than that in Group A (44 min, p < 0.001, 38 times, p < 0.001, respectively). Furthermore, the post-operative CT scan revealed that only 10.7% (6/56) of screws in Group B were inappropriately positioned according to the Smith criteria. CONCLUSION: The novel method introduced in this study demonstrated a reduction in both malposition rates and operating time compared to the traditional dual-plane adjustment method. Precise pre-operative CT planning in conjunction with conventional fluoroscopy could establish this method as a widely applicable technique for percutaneous ISS fixation.

Lag screw versus locking plate fixation for traumatic displaced medial malleolar fractures: a systematic review and meta-analysis.

BACKGROUND: Lag screw fixation (LSF) or locking plate fixation (LPF) are both recommended for the treatment of medial malleolar fractures (MMFs). However, no standard has been established for attaining optimal surgical treatment or functional recovery. We hypothesized that LPF for MMFs would result in superior outcomes compared to LSF. To test this hypothesis, we conducted a systematic review and meta-analysis of the clinical outcomes of LSF and LPF in the treatment of MMF. PATIENTS AND METHODS: We searched for studies published prior to November 2023 across the PubMed, Embase, Cochrane Library, and ClinicalTrials.gov databases. Standardization of individual effect sizes was conducted; subsequently, pooled effect sizes were derived by employing random-effects models. RESULTS: Five retrospective studies involving 394 patients were reviewed. American Orthopedic Foot and Ankle Society (AOFAS) scores were significantly higher among patients who received LPF (mean difference [MD]: 2.21; 95% confidence interval [CI]: 0.37-4.04; p = 0.02) than among those who received LSF. Pain scores were significantly lower among patients who received LPF (MD: -0.35; 95% CI: -0.64 to -0.05; p = 0.02) than among those who received LSF. No significant differences in delayed union was observed between the groups (Relative risk [RR]: 1.43; 95% CI, 0.37-4.04; p = 0.42). Fixation failure was slightly higher in patients who received LSF than in those who received LPF (RR: 3.11; 95% CI, 0.88-11.01; p = 0.08). DISCUSSION: Compared with LSF, LPF yields superior functional outcomes, superior patient comfort, and comparative complication rates. LPF is also better able to prevent rotation and apply compressive forces across fracture sites, which can facilitate the management of different types of MMF. Additional randomized controlled trials with larger sample sizes are warranted. LEVEL OF EVIDENCE: III.

Evaluating the Status and Promising Potential of Robotic Spinal Surgery Systems.

The increasing frequency of cervical and lumbar spine disorders, driven by aging and evolving lifestyles, has led to a rise in spinal surgeries using pedicle screws. Robotic spinal surgery systems have emerged as a promising innovation, offering enhanced accuracy in screw placement and improved surgical outcomes. We focused on literature of this field from the past 5 years, and a comprehensive literature search was performed using PubMed and Google Scholar. Robotic spinal surgery systems have significantly impacted spinal procedures by improving pedicle screw placement accuracy and supporting various techniques. These systems facilitate personalized, minimally invasive, and low-radiation interventions, leading to greater precision, reduced patient risk, and decreased radiation exposure. Despite advantages, challenges such as high costs and a steep learning curve remain. Ongoing advancements are expected to further enhance these systems' role in spinal surgery.